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Worry and problem-solving skills and beliefs in primary school children
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Parkinson, M. and Creswell, C. (2011) Worry and problem-solving skills and beliefs in primary school children. British Journal of Clinical Psychology, 50 (1). pp. 106-112. ISSN 2044-8260 doi: https://doi.org/10.1348/014466510X523887 Available at http://centaur.reading.ac.uk/17282/
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British Journal of Clinical Psychology- IN PRESS 2010
Brief report
Worry and problem-solving skills and beliefs in primary school children
Monika Parkinson & Cathy Creswell
Berkshire Child Anxiety Clinic
University of Reading
Contact information:
Dr Monika Parkinson
Berkshire Child Anxiety Clinic
School of Psychology and Clinical Language Sciences
University of Reading
Whiteknights
Reading
Berkshire RG6 6AL
Tel: 0118 378 6667
Fax: 0118 378 6665
Email: [email protected]
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Abstract
Objective: To examine the association between worry and problem-solving skills and beliefs
(confidence and perceived control) in primary school children.
Method: Children (8-11 years) were screened using the Penn State Worry Questionnaire for
Children (PSWQ-C). High (n=27) and low (n=30) scorers completed measures of anxiety,
problem-solving skills (generating alternative solutions to problems, planfulness and
effectiveness of solutions) and problem-solving beliefs (confidence and perceived control).
Results: High and low worry groups differed significantly on measures of anxiety and
problem-solving beliefs (confidence and control) but not on problem-solving skills.
Conclusions: Consistent with findings with adults, worry in children was associated with
cognitive distortions, not skills deficits. Interventions for worried children may benefit from a
focus on increasing positive problem-solving beliefs.
Words= 114
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Introduction
Although worry represents a universal human experience, it is more frequent and less
controllable in those experiencing anxiety disorders (Craske, Rapee, Jackel, & Barlow, 1989),
and is hypothesised to maintain high levels of anxiety and prevent effective problem-solving.
Specifically, Borkovec suggests that worry may serve as a form of cognitive avoidance, in
which people have repetitive thoughts about problems, without actually engaging in any
helpful problem-solving behaviours (Borkovec, 1985). Problem-solving also has an important
role in Dugas’ theory of intolerance of uncertainty, which is characterised by negative beliefs
about problems and one’s ability to problem-solve (and further characterised by aversion to
uncertainty, positive beliefs about worry and cognitive avoidance), and leads directly to
increased levels of worry (e.g., Dugas, Gagnon, Ladouceur, & Freeston, 2000; Dugas, Letarte,
Rheaume, Freeston, & Ladouceur, 1995; Ladouceur, Blais, Freeston & Dugas, 1998 ).
Consistent with this theory, studies with adult populations (within both clinical and non-
clinical populations) have demonstrated that those who score highly on measures of worry
do not show impairments in problem-solving skills in comparison to those with low scores,
however, differences are apparent in relation to their cognitions about problem-solving
(e.g., Davey, 1994). Specifically, compared to those with low levels of worry, participants
with high levels of worry report lower problem-solving ability, confidence and perceived
control (Davey, 1994; Dugas et al., 1995; Ladouceur et al., 1998). Furthermore, Davey, Jubb,
and Cameron (1996) experimentally manipulated participants’ problem-solving confidence
and found that reduced confidence led to a subsequent increase in catastrophic worry.
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Few studies have addressed the association between problem-solving skills and/or beliefs
and worry specifically in younger populations. An exception is the study of Laugesen, Dugas,
and Bukowski (2003) which found a relationship between negative problem-solving
orientation (beliefs and emotions about problems and own ability to cope) and higher worry
in an adolescent sample. Also of relevance, Reinecke, DuBois, and Schultz (2001) found an
association between higher anxiety and increased negative problem-solving orientation and
reduced rational problem-solving (increased avoidance and impulsivity) in adolescents (aged
12-18 years). With a younger group, Szabo and Lovibond (2004) found clinically anxious
children (aged 8-13 years) reported fewer problem-solving thoughts and successful problem-
solving behaviours than a nonclinical comparison group. These studies are, however, limited
by self-report assessments of problem-solving ‘skills’ so it is unclear whether problem-
solving skills or beliefs were assessed.
Where problem-solving has been considered within treatment programmes for youth, the
focus has tended to be on problem-solving skills, rather than beliefs and, despite the lack of
support for problem solving skills deficits in adults, it is plausible that poor problem-solving
skills may precede the development of poor problem-solving confidence in high worriers.
Problem-solving interventions have been used with some success to improve problem-
solving skills, reduce aggressive behaviour, and promote social competence (Coleman,
Wheeler, & Webber, 1993; Pelligrini & Urbain, 1985; Urbain & Kendall, 1980) however, the
impact of problem-solving skills training on worry has not been formally evaluated.
The aim of the present study was to compare problem-solving, in terms of both skills and
beliefs, in children who experience high and low levels of worry, and to establish whether
associations are specific to worry, as opposed to the general construct of anxiety.
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Method
Participants
Children were recruited through primary schools in Berkshire, U.K. Children, aged 8-11
years, from eight primary schools were invited to participate (n = 806). Where children and a
parent/guardian provided consent (n=247, 30.6%) children were visited at school and
administered (n=240) the Penn State Worry Questionnaire for Children (PSWQ-C; Chorpita,
Tracey, Brown, Collica, & Barlow, 1997). The scores showed a bimodal distribution and
groups were formed according to scores falling immediately above and below each mode
(which represented the upper and lower 12.5 centiles). Children who scored in the top
12.5% (n=30) were assigned to the ‘high worry’ group (PSWQ-C mean = 33.67, sd = 23.29,
range = 27-42); children who scored in the bottom 12.5% (n=30) were assigned to the ‘low
worry’ group (PSWQ-C mean = 8.17, sd= 2.17, range=2-11). To ensure the high worry group
was showing a consistent trait, children were reassessed on the worry questionnaire, on
average, 10 weeks later. Three participants in the ‘high worry’ group showed marked
reductions on the PSWQ-C at the second assessment (mean PSWQ = 12.66) so were
withdrawn (n=27). The low and high worry groups didn’t differ in terms of distribution of
age (low worry: mean = 116 months, high worry: mean = 114 months), family composition
(low worry: 80 % parents married/cohabitating; high worry: 72 % parents
married/cohabitating) or ethnicity (low worry: 77 % White British; high worry 74 % white
British); furthermore the ethnicity of the sample did not differ from U.K. national schools
statistics (e.g., 77% vs 78% White British). There were, however, more boys in the low than
high worry group (low worry: 63% male; high worry 33% male, χ²(1) =5.18, p= 0.02).
Measures
Penn State Worry Questionnaire for Children (PSWQ-C; Chorpita et al., 1997)
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The PSWQ-C was used as a child self-report measure of the extent and controllability of
worry. The PSWQ-C consists of 14-items to which the child responds on a 4-item Likert scale
ranging from 0 (not at all true) to 3 (always true). The PSWQ-C is widely used and has
demonstrated good test-retest reliability, internal consistency, convergent and discriminant
validity (Chorpita et al., 1997). For the current study, internal consistency for this measure
was high ( = 0.94).
Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978)
The RCMAS is a 37-item self-report questionnaire that assesses trait anxiety in children. The
RCMAS comprises 28 anxiety items and a 9 item lie scale, to which the child indicates
agreement or disagreement. The RCMAS is a widely used instrument and has been shown to
be reliable and valid for children aged 6-19 years (Reynolds & Paget, 1983). The measure has
good internal consistency (Reynolds & Richmond, 1978), content, construct and covergent
validity (Reynolds, 1985).
Alternative Solutions Test (AST; Caplan, Weissberg, Bersoff, Ezekowitz, & Well, 1986)
The AST provides a measure of children’s ability to generate solutions to age-relevant
hypothetical problems, as well as the effectiveness and level of planfulness of those
solutions. Children are given home and school based scenarios that include a problem and
are asked to generate different solutions to overcome the problem and to continue until
they are no longer able to think of ideas any new solutions. The number of alternative
solutions is recorded, and the type of solution, its effectiveness and planfulness are coded.
The AST has been found to have high test-retest reliability (Caplan et al., 1986). Thirteen
(23%) responses were coded by two raters blind to condition, high levels of inter-rater
reliability were found (response category: kappa = 0.91, p<.001; response effectiveness:
kappa = 0.96, p<.001; response planfulness: kappa = 0.85, p<.001).
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Problem-Solving Inventory – adapted for children (PSI-c)
The Problem-Solving Inventory (PSI; Heppner & Peterson, 1982) was adapted for the current
study to assess children’s perceived problem-solving ability and style. The PSI is a 35-item
questionnaire designed to measure problem-solving confidence, approach-avoidance style
and personal control (of emotions and behaviours whilst problem-solving). For the purposes
of the present study the number of items was reduced to 12 (four items in each subscale),
only incorporating those items which would be meaningful to the younger population. The
wording of the remaining items was also adapted in consultation with four 7-10 year old
children.1
Children were asked to indicate the extent to which each item was true of them on a scale
from 1 (almost never true) to 4 (almost always true). Five items were reversed to reduce
response bias. Lower scores indicate a more positive view of problem-solving (i.e. greater
confidence and control and less avoidance). The subscales achieved satisfactory internal
consistency (α = 0.84 (personal control); 0.76 (confidence)), with the exception of approach-
avoidance for which the internal consistency was low (α= 0.17). The approach-avoidance
scale was therefore not included in analyses.
Procedure
Following the initial screening phase, children in both the high and low worry groups
individually completed an assessment of worry, anxiety and problem-solving (skills and
cognitions).
1 Revised inventory available from the first author
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Results
Distributions of the data were checked to confirm that the assumptions of parametric tests
were met. Where assumptions were not met, removal of one outlier (anxiety scores for low
worry group) and logarithmic transformation (AST scores for low worry group) improved the
distribution to meet the necessary assumptions.
High vs. Low worriers
An independent measures MANOVA was used to examine the effect of group
membership on the dependent variables (number of alternative solutions, problem-solving
effectiveness, planfulness, problem-solving confidence and control). Gender was entered as
a covariate. There was a significant effect of group, which remained significant after
covarying for gender (F(5, 50) = 10.16, p<.001). Between-subjects effects were highly
significant for problem-solving beliefs (problem-solving confidence (F(1,54)=37.72, p<.001)
and perceived control (F(1,54)=37.26, p<.001), but not for problem-solving skills (number of
solutions generated, effectiveness and planfulness), see table 1.
Table 1 approximately here
As expected, the high and low worry groups showed a highly significant difference
on the anxiety measure (see table 1), therefore linear regressions were carried out to
examine further the relationship between worry and the problem-solving variables, after
controlling for anxiety. Worry was found to make a significant unique contribution to
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explaining problem-solving confidence (B = 0.14, SE(B) = 0.05, β = 0.43, p<0.01), but not
problem-solving control (B = 0.10, SE(B) = 0.06, β = 0.26, p=0.08).
Discussion
The findings of the current study suggest high worry in children is associated with negative
beliefs about problem-solving, specifically poor problem-solving confidence and low
perceived problem-solving control, yet are not associated with problem-solving skills deficits
in generating solutions, and the planfulness and effectiveness of solutions. Furthermore,
when controlling for the effects of anxiety, the results suggest a specific association between
problem-solving confidence and worry. These findings are consistent with Dugas’ proposal
that negative belief’s about problems and one’s ability to solve these maintains high levels
of worry, and previous studies that demonstrated worry and anxiety were associated with a
more negative problem-solving orientation for non-clinical (Laugesen, Dugas & Bukowski,
2003) and clinical adolescent populations (Reinecke, Du Bois & Schultz, 2001). Unlike Szabo
and Lovibond (2004), however, skills deficits were not found (although notably that study
relied on self-reported skills deficits, which may arguably be more an assessment of problem
solving cognitions). Our findings are consistent with studies with adults that have suggested
negative problem-solving beliefs (and not skills deficits) are associated with increased worry
(Davey, Jubb & Cameron, 1996), and further examination of the nature of the relationship
between problem-solving beliefs and worry in youth is clearly warranted.
The current study used a novel measure of problem-solving beliefs, adapted for children
from the Problem-Solving Inventory (PSI; Heppner & Peterson, 1982). The measure had good
face validity and psychometric properties of the confidence and control scales, however, the
internal consistency of the avoidance scale was inadequate. Thus the current study was
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limited to exploration of problem-solving ‘skills’ and ‘beliefs’ and was unable to assess
problem-solving ‘style’ , which may well distinguish children with high and low worry (e.g.,
Barrett, Dadds, & Rapee, 1996; Reinecke et al., 2001). Limitations regarding generalisability
should be acknowledged. The study response rate was relatively low which may have
introduced a bias, although it is encouraging the final sample did not differ from UK national
statistics on demographic factors. In forming the two worry groups from our community
sample by using high and low cut-off scores on the worry measure, there is the possibility
that the low worry scores do not represent a normative group and replication comparing, for
example, children with Generalised Anxiety Disorder to non-clinical controls is warranted.
Whether the data can be generalised to clinical populations also requires further study,
however, it is notable that the level of anxiety reported by the ‘high worry’ group
approached clinical cut-offs (Stallard, Velleman, Langsfor, & Baldwin, 2001).
The current study provides support for an association between worry and negative problem-
solving beliefs, specifically low problem-solving confidence, in primary school aged children,
and their application to clinical populations, warrants further research attention. Early
investigations with young adults have shown promising outcomes from cognitive
approaches aimed at negative problem orientation (Leger, Ladouceur, Dugas, & Freeston,
2003). Our findings, while preliminary, are consistent with the suggestion that interventions
with children who experience high levels of worry may benefit from the inclusion of
procedures to specifically target problem-solving beliefs.
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Table 1
Worry, anxiety, problem-solving beliefs and skills
Low worry group
(mean, sd, range)
N=30
High worry group
(mean, sd, range)
N= 27
F
Total worry
(PSWQ-C)
9.63
(4.58, 0-17)
28.44
(6.12, 20-41)
170.19***
Total anxiety
(RCMAS)
6.00ˡ
(4.29, 0-15)
18.37
(4.96, 8-27)
84.12***
Problem-solving
confidence (PSI-c)²
9.37
(2.61, 5-14)
14.04
(3.06, 6-20)
37.72***
Problem-solving
control (PSI-c)²
7.97
(2.55, 0-12)
12.89
(3.84, 7-20)
37.26***
Total number of
alternative
solutions (AST)
12.20
(3.36, 8-21)
12.19
(2.83, 7-17)
0.02
Effectiveness of
solutions (AST)
(average per story)
2.80
(0.39, 1.80-3.50)
2.91
(0.34, 2.33-3.42)
1.12
Planfulness of
solutions (AST)
(average per story)
0.15
(0.15, -.11-0.45)
0.18
(0.17, -0.23-0.50)
0.05
ˡ n=29 (1 outlier excluded)
² higher score indicates lower confidence/control
** p<0.01; *** p<0.001
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